Provider Demographics
NPI:1265670194
Name:BRUSCHI, GARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:BRUSCHI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 CENTRAL PARK W
Mailing Address - Street 2:APT. 11 L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6054
Mailing Address - Country:US
Mailing Address - Phone:212-769-0977
Mailing Address - Fax:
Practice Address - Street 1:10 GRACE AVE
Practice Address - Street 2:SUITE 12 D
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2423
Practice Address - Country:US
Practice Address - Phone:515-773-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007179103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist